Morbidly obese and skin care

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    I am at a loss. One of my residents skin keeps breaking down. Under her belly roll, buttocks, arms. Could someone give advice on what to put under the belly when the skin starts bleeding. I have tried powder, selan cream and then putting a sheet or towel under the roll. Her bottom is breaking down also and I spray it with granulex while toileting her. She can not turn on her side in bed as the bed is not wide enough. So when in bed she lays flat with her head elevated. Any advise would help. Thanks.
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    Quote from rdop5388
    I am at a loss. One of my residents skin keeps breaking down. Under her belly roll, buttocks, arms. Could someone give advice on what to put under the belly when the skin starts bleeding. I have tried powder, selan cream and then putting a sheet or towel under the roll. Her bottom is breaking down also and I spray it with granulex while toileting her. She can not turn on her side in bed as the bed is not wide enough. So when in bed she lays flat with her head elevated. Any advise would help. Thanks.
    How unfortunate.

    Is the rash and breakdown consistent with candida? If you are not familiar with what that looks like, either collaborate with a colleague or bing it (candida rash + image).

    Sounds like she needs a different bed (bariatric preferrably) and a low pressure mattress. This woman is totally bedridden and dependent? As you likely already know, moisture, immobility, pressure, and friction are her (and your) enemies. Frequent intervention designed to keep her clean, dry, and off the pressure points would be my focus along with whatever pharmacologic treatment is indicated.
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    Like tewdles suggested - could it be yeast? alot of people respond to using an antifungal powder (ie. Microguard powder). Using antifungal powder is alot easier to dust on rather than trying to apply a lotion (prescription or otherwise) Could it be aggrevated by a contact dermatitis? like the detergents or hygiene products being used?
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    Thanks all. I really don't think it's yeast. But there is an odor. The crack of the fold gets really red, then sometimes bleeds. She has had a blister pop up and took a week then it went away with antibiotic and dressing. The other things look like skin tears on the inner fold. It is so big and tight that I have to have an aide hold it up for me just to get in there and look. Maybe I will try the fungal powder. It just doesn't have the look of yeast. Yes she is pretty dependant on us. We have to use the lift to get her to the bathroom, and into her WC. She has her mind more of less, so it is hard to get her to eat right as she sure likes the PBJ sandwiches everyday. I also have put in for the bigger bed. Hopefully she gets it. Thanks folks and keep the suggestions coming. This lady is very special. And it sure is early so excuse my writing. Thanks.
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    It sounds like an antifungal powder like Nystatin powder, just use generic, would help the abdominal fold and place a clean, dry washcloth there to stop the skin to skin contact. Then, a low air loss mattress would help the pressure points. Then you only have to worry about shear. If you can't get a low air loss mattress, just turning by degrees helps, you don't have to go side-to-side. A Roho-type cushion would help in the w/c. Just focus on trying to maintain clean, dry skin and decrease the pressure areas the best you can. Make sure the sling for the full body lift is not kept under her in the w/c. And anything between the pressure reduction mattress or cushion and the resident cancels out the good of the interventions. Hang in there!!


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